Provider Demographics
NPI:1437292562
Name:ARTESIA PHARMACY
Entity Type:Organization
Organization Name:ARTESIA PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST & OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-371-8866
Mailing Address - Street 1:2301 ARTESIA BLVD STE 11A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3100
Mailing Address - Country:US
Mailing Address - Phone:310-371-8866
Mailing Address - Fax:310-371-5077
Practice Address - Street 1:2301 ARTESIA BLVD STE 11A
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3100
Practice Address - Country:US
Practice Address - Phone:310-371-8866
Practice Address - Fax:310-371-5077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 35730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA 357300Medicaid